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(Submit minimum of 2 sets of plans & applications as originals will be retained by EHD) <br />1. Site map enclosed YES N NO [I <br />2. Manufacturer's spec sheets attached for all equipment to be installed YES T-1cNO[ ] <br />3. Description of work to be completed (If adding piping, UDC's, or other UST equipment, or performing tank top upgrade, <br />use the UST Installation Application pages 4-8 as necessary for a timely plan revlew): <br />Connecting new fuel supply and return piping to existing fuel system. This <br />piping is to supply a new emergency back-up Sener <br />and piping to remain intact and functional per or <br />4. Description of equipment to be used (Attach drawings/blueprints as necessary): <br />Primary -S/40 A120/A53 Black pipe T&C with 150# <br />Secondary - Fiberglass pipe with Clam Shell stti <br />5. All equipment is State certified or approved. YES Pq NO [ ] <br />8. Decontamination Procedures: N/A <br />nal aesign. <br />MI screwed fitt <br />a. Will piping be decontaminated prior to removal? YES [ ] NO[] <br />b. Identify contractor performing decontamination: <br />Name Phone(}' <br />Address City Zip <br />c. Describe method to be used for decontamination: N/A <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: N/A <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: N/A <br />Hauler Name Phone(_) Hauler Reg# <br />Address City Zip <br />Permitted Disposal Site <br />a. Describe the method that will be utilized to purge and/or inert the piping: N/A <br />b. Piping Hauler: <br />Name Phone ( } <br />Address City Zip <br />Hauler Registration # (if hauled as hazardous) <br />c. Piping Disposal Site: <br />Name Phone (_) <br />Address City Zip <br />EPA ID# (if transported to a permitted TSD facility) <br />8. Is the sampling firm an independent third parry from the contractor? YES [ ] NO [] <br />9. Describe, in detail, how the soil and/or water sample(s) beneath the piping or dispenser will be obtained: N/A <br />ild <br />Handling of excavated soil (Contaminated Soil Hazardous Waste Hauler): <br />Name Hauler Registration # <br />Address City <br />b) If soil is not to be hauled, describe what will be done with it: N/A <br />N/A <br />Phone ( ) <br />Zip <br />